Sticking point

The Homeless Youth Alliance (HYA) has quietly operated a drop-in center and needle exchange program in the Haight for the last 10 years. Until last month, very few people besides their clients even knew they existed.

Then the San Francisco Chronicle ran a series of overheated articles about used syringes littering Golden Gate Park. One of the pieces singled out HYA for handing out drug needles "by the double handful."

But the HYA and similar groups have long urged city leaders to deal with needle waste, urging them to install the type of needle collection receptacles used in other cities that share San Francisco's official "harm reduction" approach to drug use. "We've been trying to get disposal boxes [for syringes] into the park for over a year and a half," HYA executive director Mary Howe said.

Yet Mayor Gavin Newsom and his administration have ignored that advice  apparently concerned about its political implications  and have instead ordered police and outreach workers to crack down on the homeless.

"Since the [Chronicle] articles, a few people have decided to stroll in off the street and tell us what they think of us," Howe told the Guardian. "Clearly, they want to think that the syringe problem is on me and on the needle exchange."

But Howe and other public health experts say San Francisco's 15-year-old needle-swap program has not only dramatically contained HIV, Hepatitis C, and other deadly diseases among IV drug users, it also has actually reduced the number of cast-off needles in public spaces.

Santa Cruz, New York, Baltimore, Vancouver, and many other cities feature disposal boxes in drug hot spots. New York State Department of Health spokesperson Claire Pospisil told us her agency has more than 80 such receptacles around the state. While Newsom has borrowed get-tough programs like community court (for quality-of-life offenses generally committed by the homeless) and some aspects of his Care Not Cash plan from New York, his administration nixed requests to put the boxes in.

Instead, shortly after the first Chronicle articles appeared in late July, the city launched another crackdown on people sleeping in the park, as other mayors before him have done during election years. But several public health and law enforcement professionals told us the raids will never rid the park of addicts looking for a safe place to fix  or the occasional used needle that they leave behind.

"It's one thing to sweep the park and displace an entire community if you have someplace to put them," Howe argued. "But they don't have any place to put them."

Howe said her attempts to have syringe containers placed in the park are consistent with the San Francisco Health Commission's seven-year-old "harm-reduction" mandate, which calls on city health workers and city-funded contractors like needle-exchange programs to minimize, as much as possible, the health dangers associated with drug abuse. Used needles, Howe contends, count as one of these dangers.

But Newsom spokesperson Nathan Ballard confirmed by e-mail that the administration has considered and rejected the idea for now. "The mayor is not eager to put such boxes in the park," Ballard wrote. He added that Newsom has asked the Health Department to consider installing "receptacles ... in the right places," but when we asked him in a follow-up e-mail where such "right places" might be, he did not respond.

Rose Dennis at the Recreation and Park Department said that, in the past, the department "floated the idea" of disposal boxes at public meetings. But when it became clear that the containers would not be politically popular, the department quickly gave up on them. "People were really, profoundly opposed to it ... and we just didn't have the confidence that we weren't going to be vilified for it," Dennis said. "We're not just going to politically put our asses out there just because someone has an idea."

Several sources in the public health profession lamented this kind of political ass-covering. Dr. Alex Kral, a noted San Francisco epidemiologist, told us, "It's not that we don't have solutions to these problems. We have solutions. The problem is the politics.... If you take the politics out of it, we should have syringe disposal boxes in the park and wherever [IV drug users] congregate. At the very least we should have them at the edges of the park."

Even C.W. Nevius, the Chronicle columnist who stirred up the syringe controversy in the first place, supports Howe's disposal box proposal. "What's the downside of putting these boxes in?" he told us. "People might think that boxes would somehow encourage people to use drugs in the park, but the reason why [drug users] stay there would not be because there are these boxes."

Nevius added that Newsom called him after his columns came out and "yelled at me for 45 minutes.... He was very upset with the stories and the way they showed what's happening."

Ballard touted the city's aggressive new actions to clean up Golden Gate Park. He said that, in addition to the recent raids on homeless encampments, 13 new Rec and Park patrol officers will be dispatched to the park within a month, and "we're adding additional HOT [homeless outreach] teams to connect more homeless people to the services they need."

Lt. Mary Stasko at the San Francisco Police Department's Park Station explained how social workers in the HOT teams interact with park squatters during the early morning operations. "The outreach teams go with the police officers and the clean-up crews, and they tell people, 'We can put you in a bed tonight, we can give you a hot meal right now if you come with us.'

But Stasko was doubtful that sweeps alone will stop homeless drug users from returning to the park. City shelters do not permit substance use, she reasoned, meaning anyone who wants to accept the HOT teams' offers must choose immediate abstinence. "For the people who are interested in quitting, [the city's new outreach efforts] are working like a charm. But then you have the hard-core people who don't want to stop using. They're the ones who end up coming back. Those are the types that have been in the park since 1967."

Canadian epidemiologist Dr. Evan Wood cited San Francisco's "high-threshold," abstinence-only approach to services as a major factor in Golden Gate Park's chronic cycle of homelessness and substance abuse. He has been involved with implementing Vancouver's successful "safe injection site," where people can safely shoot up and dispose of their needles. Similar facilities are already widespread in Europe.

"Trying to simply eliminate these behaviors does not work," Wood went on. "You have to meet these people on their turf."